Andrew Coates: Why Are They All Saying "Single Payer?" | WAMC

Andrew Coates: Why Are They All Saying "Single Payer?"

Nov 1, 2013

Last week we saw a domestic national news cycle dominated by the "glitches" that derailed the launch of the web-based exchanges where uninsured American people and their small business employers can shop for private health insurance. This week, as stories about private health insurance continue to dominate the headlines, the term "single payer" has bobbed up with increasing frequency.

"Single payer" or “Medicare for All” has simultaneously appeared on the lips of many mainstream voices, right, left and center. Mostly those who say the words would like to dismiss the idea -- and yet they clearly recognizethat the single payer proposal, public health insurance for each and all, is a policy proven to guarantee access, improve health outcomes and control costs.

The latest media flashpoint shines a light on an estimated 10 to 15 million people who already purchase private health insurance individually. Many of these people have been getting letters from their insurance companies canceling their policies at year's end.

Republicans pounced on the occasion to embarrass the President, accusing him of false promises. Mr. Obama had often claimed that under his reform, "If you like your health insurance, you can keep it."

In his defense the President explained that the Affordable Care Act places new regulation upon the insurers, that it establishes basic minimum coverage thresholds, that insurers can no longer exclude applicants due to pre-existing health conditions, that millions of people will be income eligible for Medicaid or federal subsidies to cover private insurance premiums.

In other words, although you might not be able to keep your woefully inadequate policy that you liked for its low premiums (but might have hated in the event you actually got sick!), there is a chance that you will get a new policy, and perhaps a subsidy toward its premium costs, something you might like after all.

But as an axiom from establishment politics of the 1980s runs -- "if you're explaining, you're losing." Hearing the President's explanations, the Republicans stepped up their criticism.

The media, for the most part, has played its usual part too, repeating the the talking points -- "he said, she said." Yet few journalists have pointed out that the mainstream debate, although flamboyant in style, -- press conferences, Congressional hearings, talking heads galore -- remains perfectly flat in substance.

The President and his party tout the virtues of private health insurance. In vociferous opposition, the Republicans and their Tea Partiers tout the virtues of private health insurance.

But then comes the double irony -- something funny happened on the way to covering this forum. As journalists looked for the story beneath the story, they come across real human beings caught in this odd political crossfire.

We're told stories about people who desperately need private insurance and are grateful for the chance to purchase it in order to escape ongoing financial ruin. Poignant articles have underscored how whole families can be devastated financially by "out of network" costs (and some by “in network” costs). We read about people whose households now live with extreme insecurity, as their employers or their insurers have cancelled their policies.

Private health insurance has not only failed to cover everyone, but it often proves incapable of adequately covering anyone, especially any one of us who faces a grave illness. Health insurance is not the same as health care.

On top of this, private health insurance is basically an enormous personal hassle -- not something we like, but something we're forced to grapple with. It’s something we’re happier to have than not have, but it’s also something we’re stuck with.

Everyone knows that those without insurance face high barriers to getting care and are more likely to die than those who have it. Does this explain the latest news cycle? I think not, because both Republicans and Democrats want us to buy private insurance, which erects its own high barriers – premiums, deductibles, and co-pays, for example.

More to the point, I'm sure that each of us -- everyone listening today -- knows a family member or a friend who has speculated on whether the Affordable Care Act might help them in a personal way with getting private insurance … and maybe getting to see a doctor.

So it’s a double-edged sword. Private insurance, while considered desirable by many, introduces its own insecurities and uncertainties into our daily lives. I think that is what’s driving the mainstream discussion. And if we dig a little deeper, when it comes to health care, everyone knows that we are all in this together.

If we're all in this together, why not a system based upon that very idea? Why not a truly universal, improved Medicare for All? And that explains why we have all of a sudden also heard so many voices, right, left and center, comment upon the single-payer solution to our health crisis.

Dr. Andrew Coates practices internal medicine in upstate New York. He is President of Physicians for a National Health Program.

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